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Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) Screening of HIV based on indicator conditions and risk behaviors at the emergen...
Journal Information
Vol. 36. Issue 6.
Pages 392 (June - July 2018)
Vol. 36. Issue 6.
Pages 392 (June - July 2018)
Letter to the Editor
DOI: 10.1016/j.eimce.2018.04.011
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Screening of HIV based on indicator conditions and risk behaviors at the emergency departments
Cribado del VIH con base en condiciones indicadoras y conductas de riesgo en los servicios de urgencias
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Juliana Reyes-Urueñaa,b,c,
Corresponding author
jmreyes@iconcologia.net

Corresponding author.
, Laura Fernàndez-Lópeza,b,c, Jordi Casabonaa,b,c,d
a Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Barcelona, Spain
b Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain
c Fundació Institut d’Investigació Germans Trias i Pujol IGTP, Badalona, Barcelona, Spain
d Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Universidad Autónoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
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Dear Editor,

In relation to the letter addressed to the editor by Argelich-Ibáñez and Juan-Serra1 referring to a study carried out by our research group2 on HIV screening in an emergency department (ED), we agree with the authors that the availability of HIV testing—using rapid diagnosis techniques—in EDs aimed at the population with risk factors and/or indicator conditions is necessary. This is because routine HIV testing in non-specialist environments has the potential to significantly reduce both late diagnosis and treatment access barriers.3 Furthermore, it increases the likelihood of identifying the number of undiagnosed infections, thereby requiring less testing and improving the efficiency of testing, which makes the strategy cost-effective.3,4

Nevertheless, the feasibility of including screening programmes in EDs largely depends on the ability to integrate HIV testing in the EDs, and on how the programmes are funded.5 The most cost-effective strategy described by other authors is to include an HIV screening programme within the ED with new personnel, especially nursing personnel, which ensures a relatively immediate guided transition of patients with a positive diagnosis to the specialist services3 and helps to gain patients’ trust in the healthcare provider and in the healthcare system by providing support and direct comprehensive HIV care.3 These programmes can offer detection tests to all potential patients, with a wide testing coverage and with lower costs per test.6 However, this staffing model, parallel to that of the ED, requires multidisciplinary collaboration (ED personnel, HIV units and public health professionals), which involves resources and investment in infrastructure.3 In addition, it results in a limited evaluation of HIV due to the lack of availability of personnel to carry out HIV testing 24 hours a day.6

Therefore, the ideal situation is to have an HIV screening programme in EDs targeted at the population with risk factors, using appropriate criteria which increase the sensitivity of the programme, through a programme implemented in EDs with nursing staff that guarantees: the screening of individuals; proper performing of the test; and the introduction of patients newly diagnosed with HIV to specialist care. Given the limited resources in our setting, creating a programme with these characteristics would be quite complex. Therefore, in line with Argelich-Ibáñez and Juan-Serra,1 and in our current setting, it is not possible to implement a screening programme given the limited resources, but we believe that HIV testing using rapid diagnostic techniques should be available in EDs, where HIV should be ruled out based on the indicator conditions and risk behaviours.

In terms of the low prevalence of new diagnoses of HIV found in our study, we believe that it is: (1) secondary to the possible absence of a hidden epidemic in the low-risk population; (2) due to the low efficiency of universal screening in this department,3,6 and (3) due to the study's operational constraints, as there was only one nurse offering the test in an ED with a very high number of visits, and in which screening depended on the availability of the nurse.

References
[1]
R. Argelich Ibáñez, N. Juan-Serra.
Cribado del virus inmunodeficiencia humana: ¿es apropiado en los servicios de urgencias hospitalarios?.
Enferm Infecc Microbiol Clin, (2017),
[2]
J. Reyes-Urueña, L. Fernàndez-López, L. Force, M. Daza, C. Agustí, J. Casabona.
Estudio del impacto a nivel de salud pública del cribado universal del virus de la inmunodeficiencia humana en un servicio de Urgencias.
Enferm Infecc Microbiol Clin, 35 (2017), pp. 434-437
[3]
M. Hempling, A. Zielicka-Hardy, J. Ellis, W. Majewska, G. Fida.
Routine HIV testing in the emergency department: feasible and acceptable?.
Int J STD AIDS, 27 (2016), pp. 1267-1274
[4]
L.A. Kennedy, F.M. Gordin, V.L. Kan.
Assessing targeted screening and low rates of HIV testing.
Am J Public Health, 100 (2010), pp. 1765-1768
[5]
J.S. Haukoos, D.A. White, M.S. Lyons, E. Hopkins, Y. Calderon, B. Kalish, National Emergency Department HIV Testing Consortium, et al.
Operational methods of HIV testing in emergency departments: a systematic review.
Ann Emerg Med, 58 (2011), pp. S96-S103
[6]
A. Spaulding, R. MacGowan, B. Copeland, R. Shrestha, C. Bowden, M. Kim, et al.
Costs of rapid HIV screening in an urban emergency department and a nearby county jail in the Southeastern United States.

Please cite this article as: Reyes-Urueña J, Fernàndez-López L, Casabona J. Cribado del VIH con base en condiciones indicadoras y conductas de riesgo en los servicios de urgencias. Enferm Infecc Microbiol Clin. 2018;36:392.

Copyright © 2017. Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica
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